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Anaesthetists should be involved in audit cycles, preferably using a ‘rapid-cycle’ quality improvement approach. These benchmark standards of care, and may be an effective change driver.  This approach is an excellent way of providing evidence of good practice as defined by the GMC, and mapping the contribution that individuals make to any service within their hospitals.^{58,128,129,211}

Where interventions are unlikely to alter outcomes and may add to patient distress, this should be recognised and communicated with the patient and their relatives or supporters at the earliest opportunity.²²⁹

A team approach should be considered for breaking bad news and discussions around futility and end of life decisions with patients and relatives. 

Preoperative assessment, optimisation, manipulation of patients’ normal drugs and shared decision-making in patients with diabetes requires a cross specialty approach involving anaesthetists, surgeons, diabetologists and diabetes inpatient specialist nurses. The development of such teams requires time and resources. This should be recognised and provided.³⁸

Discussion and reasons behind decisions taken, as well as the information given to the patient and relatives, should be clearly recorded.^230,231

Hospitals should have pathways to alleviate pain and suffering, which should be individualised to the needs of the patient and discussed with their relatives or supporters.²³²

Hospitals should have local guidelines for when a patient dies in theatre or soon after in recovery.  This should include arrangements to maintain dignity for the patient and to give relatives the best support possible. It should also include arrangements to minimise the impact on other patients being treated in the theatre complex.⁶⁰

Hospitals should offer the same level of access for discussion and explanation to relatives of patients who die in the theatre complex, or don't undergo surgery, as those who die in critical care. 

Where end of life care is instituted, this should be in accordance with national and local guidance and audited for quality in the same way that surgical care is audited.²³³

Hospitals should have a DNACPR guidance and documentation that complies with national requirements.^96,231